International Journal of Legal Medicine

https://doi.org/10.1007/s00414-018-1855-z

CASE REPORT

A moving human body causes fatal blunt trauma: an unusual

traffic accident
Annette Thierauf-Emberger 1 & Andreas Lickert 2 & Stefan Pollak 1

Received: 6 February 2018 / Accepted: 11 May 2018

# Springer-Verlag GmbH Germany, part of Springer Nature 2018

Abstract
In urban traffic accidents, mainly pedestrians and cyclists are at risk of being injured and killed. Lethal injuries are usually caused
by the immediate impact of a car or a tram. This paper presents a fatal accident without any direct contact with a motor vehicle. A
63-year-old woman sitting on a chair in a pavement cafe was killed by the impact of a 60-year-old male cyclist, who was flung in
her direction after colliding with a car. Autopsy yielded intracutaneous haemorrhages on the impact sites of the female victim (left
cheek, left shoulder and left upper arm). The woman sustained a ring fracture of the skull base encircling the foramen magnum
with subtotal severance of the brain stem and massive chest trauma. All the injuries were caused by the blunt impact of the
moving human body. The head was forcibly bent towards the contralateral shoulder resulting in a depression fracture of the skull.
Reconstruction of the accident at the scene was challenging, as the fatally injured victim remained sitting on the chair and did not
show any striking external signs of traumatisation. According to the assessment of the technical expert, the collision velocity of
the moving body amounted to 6–8 m/s.

Keywords Traffic accident . Human-human impact . Blunt force . Craniocerebral trauma

Introduction 393,432 people were injured in traffic accidents [4]. Due to

According to the Federal Statistical Office of Germany,
925,200 people died in Germany in 2015 [1]. Among those
were 3573 victims of traffic accidents (0.4%) [2]. The World
Health Organization (WHO) stated that 1.25 million people
had died from road traffic injuries worldwide in 2013 [3].
According to the WHO, the estimated road traffic death rate
(per 100,000 people) was 2.9 in the UK, 4.3 in Germany, 10.6
in the USA, 18.8 in China and 18.9 in the Russian Federation
[3]. On average, high-income countries show lower road traf-
fic death rates than regions with a low average income [3].
Traffic accidents are a frequent occurrence worldwide as
well as in Germany: In 2015, 2,516,831 crashes were recorded
by the German police, among those 305,659 with injury to
persons [4]. Apart from the above-mentioned fatalities,
higher velocities, car passengers are at risk of being fatally
injured primarily on extra-urban roads. In contrast to this, in
urban accidents, mainly pedestrians (377 deaths in 2015 in
Germany) and cyclists (236 deaths) are harmed and killed [4].
Lethal injuries are mainly caused by the direct impact of the
involved vehicle whereas serious bodily harm caused by a
human body accelerated as part of a traffic accident seems to
have hardly ever been published. A literature search did not
produce any results to that effect.
In the following, such a traffic accident is presented in
which a woman was killed who was not hit by a vehicle or
parts of it, but by another human being. Reconstruction of this
accident was challenging, because externally the killed wom-
an did not show typical signs of impact one would expect after
a fatal collision.

* Annette Thierauf-Emberger Case report

annette.thierauf@uniklinik-freiburg.de
Case history
1
Institute of Legal Medicine, University of Freiburg, Faculty of
Medicine, Albertstrasse 9, 79104 Freiburg im Breisgau, Germany On a bright day in early summer, an 84-year-old man lost
2
Dekra Automobil GmbH, Freiburg im Breisgau, Germany control of his car in the pedestrian zone of a small town. The
 Int J Legal Med

man claimed that he had mixed up the brake and accelerator

pedals after colliding with a cyclist. Witnesses reported that
the car had accelerated already prior to the collision. More
than 20 persons were injured, and two individuals died in
the accident. One of them was a cyclist, who was scooped
up by the car and carried along for a short distance. When
the vehicle turned right, the cyclist was thrown off and con-
tinued to move in the initial direction of the car. Next to his
final position, a woman was found dead in a pavement cafe
where she was sitting on an undamaged chair next to the wall
of the house (Fig. 1). At first sight, the woman seemed to be
uninjured. Her clothes fitted properly. Her arms were still lo-
cated on the arm rests of the chair and her legs were crossed.
The head rested on the right shoulder. No possible cause of
death was visible from outside.

Autopsy findings of the female victim

External examination Fig. 2 Intracutaneous haemorrhages on the left upper arm

Autopsy of the 63-year-old woman (body length 161 cm,
body weight 50 kg) was performed 41 h after death.
External examination of the body showed intracutaneous
haemorrhages on the left cheek, the left shoulder and the left
upper arm (Fig. 2). The right temporal and parietal parts of the
hairy scalp were bruised. Furthermore, a monocle haematoma
was found on the right side. Lividity was sparse.
Internal examination of the body
There was a ring fracture of the base of the skull encircling the
foramen magnum (Fig. 3); the brain tissue between the me-
dulla oblongata and the pons was subtotally severed, and both
crura cerebri were overstretched (Fig. 4). On the right side of
the skull, a depressed fracture involving the parietal, temporal

Fig. 1 Dead woman on the chair Fig. 3 Ring fracture encircling the foramen magnum
Int J Legal Med
Fig. 4 Subtotal severance of the brain stem between the medulla and pons
and occipital bone was discernible (Fig. 5); in this area, the
dura mater was torn. The skullcap showed a gaping linear
fracture, and the base of the skull was irregularly fractured.
Furthermore, the right mandible, both clavicles and the
manubrium sterni were broken. There was an extensive haem-
orrhage in the soft tissue of the right upper parts of the thorax.
Serial rib fractures were found on both sides of the thorax. The
right lung was completely severed from the hilus, and the
upper lobe of the right lung was ruptured. The left main bron-
chus was disrupted. Further findings included blood aspiration
(most likely from the ring fracture of the base of the skull),
Fig. 5 Depressed fracture of the right parietal, temporal and occipital
bone
bilateral haemothorax and contusions of both the lungs and
the heart. The right carotid and subclavian arteries were sev-
ered from the aorta. Apart from that, the carotid arteries were
intact. The inner organs were pale and anaemic.
Further pathological findings were moderate emphysema,
discreet arteriosclerosis and haemangioma of the liver.
Death was due to severe blunt craniocerebral and thoracic
trauma. No ethanol was found in the blood.
Autopsy findings of the cyclist
The autopsy of the cyclist was performed by a different insti-
tute of legal medicine. According to their report, the main
injuries of the 60-year-old man (body length 176 cm, body
weight 89 kg) were the following: laceration on the forehead,
excoriations on the right side of the head, fracture of the right
orbita, small haemorrhages in the right temporal lobe of the
brain, fracture of the 7th thoracic vertebral body, serial rib
fractures on both sides of the thorax, fracture of the right
scapula and the right humerus, fracture of the pelvic ring,
rupture of the right heart atrium, décollement on the right
hip and lower back, décollement on the exterior right lower
leg, laceration on the left arm. According to the report, the
cyclist died from severe thoracic trauma. The décollements
were erroneously assumed to be the result of being run over
by the car, although no tyre marks [5] were visible on the
victim’s clothes and skin.
Police and technical investigations
Due to the complexity of the traffic accident and the initial
lack of clarity regarding the course of events (contradictory
witness statements), a technical expert was called in by the
police. In his report, he describes a collision between the left
front part of the car and the right side of the bicycle rider. As
mentioned above, the cyclist had been scooped up by the car
and thrown off again when the car made a turn to the right
(Fig. 6).
At the time of collision, the speed of the car was approxi-
mately 40–45 km/h corresponding to 11–12.5 m/s. According
to crash tests, the speed of a scooped-up cyclist adjusts to the
speed of the car. Subsequently, the deceleration of the cyclist
was about 5 m/s2. The collision with the woman occurred after
a distance of about 8.5 m. On the basis of these values, the
impact speed was approximately 6–8 m/s. Assuming a linear
impact and a mass proportion of 1:2 (the woman was hit only
on the upper part of the body), the Δv for the woman’s thorax
was 6 to 10 m/s according to the principle of linear momentum
considering that the cyclist flew on 1 m after the collision
while being decelerated by about 3 m/s.
The injuries of the cyclist corresponded to the technical
assessment, but not to the initial assumption that the man
had been run over by the car. There was no contact between

Fig. 6 Sketch of the accident (original position of the chair with 90° clockwise rotation)
the car and the woman sitting on the chair. For the preparation
of the technical assessment, the video footage of a surveillance
camera was available, but the video sequence did not show
either of the collisions.
Discussion
At the scene, it was initially unclear how the accident had
happened. This mainly applied to the death of the female
victim, while the damage on the car and the bike indicated a
collision of these vehicles. The woman was declared dead on
the spot, but did not show any major external injuries. Her
position on the chair and the lack of damage to the chair were
striking. There were no clues at first why this female victim
had died.
During autopsy, first signs of trauma were found in the
form of intracutaneous haemorrhages on the left cheek, shoul-
der and upper arm indicating a blunt force impact. The internal
traumatic findings on the head and thorax supplied further
evidence for this assumption. The massive impact to the head
caused a relative movement in relation to the spine (traction)
resulting in a ring fracture of the base of the skull and injuries
of the brain stem [6]. The head was bent to the side and
pressed against the contralateral right shoulder, which resulted
in a depressed fracture of the skull.
After autopsy, it was clear that the woman had been in-
volved in the accident. But it was still unclear which object
had hit her. The absence of excoriations suggested rather a soft
surface. The severity of the injuries implied a heavy object.
Due to these conditions and the proximity of the body posi-
tions (woman and cyclist), the idea came up that the woman
had been hit by the cyclist thrown off the car.
Int J Legal Med
In the further course of the police investigations, this ver-
sion was confirmed by the testimonies of witnesses, video
footage and technical evidence. It became obvious that this
was a traffic accident with an unusual course of events. Thus,
the woman had not been killed by the direct impact of a vehi-
cle, but by another human being who had been flung in her
direction due to prior collision with a car. The man weighed
89 kg, so that the kinetic energy was sufficient to explain the
massive and lethal trauma of the woman.
The cyclist sustained complex injuries of the head, tho-
rax and right lower leg by repeated blunt traumatisation.
At the end of the technical and forensic reconstruction, it
was clear that he had not been run over by the car. In the
authors’ opinion, the décollements on the right side of his
body (lower leg and hip) had to be attributed to the cy-
clist’s initial contact with the car. The head and thorax
injuries were caused, when he was scooped up by the
car, collided with the woman and finally hit the ground.
It was not possible, though, to definitely assign certain
injuries of the cyclist to the secondary collision with the
woman.
This accident attracted much public attention not only
due to the circumstances, but also because of the age of
the driver. Could the old age of the car driver have played
a role? Due to demographic changes and the increasing
average age of the population, the fitness to drive of el-
derly people has been frequently questioned [e.g. 7–9].
According to an expert in traffic medicine and psycholo-
gy, a reduced fitness to drive played an important role in
the accident presented here. The man was given a
suspended prison sentence of two years and a lifelong
ban on driving. Additionally, a fine of 1500 € was
imposed.
Int J Legal Med
Conclusion 2.
We present an unusual case of a fatal traffic accident. A wom-
an sitting on a chair died of severe craniocerebral and thoracic 3.
trauma, which was not caused by the impact of a vehicle. The
injuries were the result of a collision with another person,
4.
who, as a cyclist, had been hit by a car, scooped up by it and
thrown off again. The woman, who had been sitting on the
chair, was declared dead still at the scene, but did not show
any external signs of massive trauma. This emphasises that the 5.
diagnostic value of an external post-mortem examination only
is limited [10]. Even if death was caused by severe mechanical
impact, the outer findings may be sparse and unspecific, thus 6.
providing no clues to the internal injuries. This explains why
the skin has been said to sometimes mask the internal trauma
7.
[11]. In the present case, the sites of impact were indicated by
patterned intracutaneous haemorrhages reflecting the weaving
structure of the interposed textiles [12].
The case reported here underlines again the importance of 8.
medicolegal autopsy in the reconstruction of accidents. Only
the synopsis of all findings permits a thorough assessment of
9.
the circumstances of the accident.
10.
11.
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